Overview:

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, employees have an opportunity to make a positive impact on the quality of our health plan members' lives.

Responsibilities:

Process all requests for services in accordance with Medicare and NYS Medicaid Guidelines as well as departmental criteria and guidelines. Works collaboratively with other disciplines including Care Manager, Assessment Nurse and Primary Care Physician or other Specialists as necessary to ensure timely provision of services. Coordinates timely completion of UAS NY assessment that accurately reflects current condition of the member. Ensures that the member’s Individualized Person Centered Care Plan has been updated and accurately reflects present status of the member.

Qualifications:

Graduate of an accredited nursing program, Bachelor’s preferred

Knowledge with Utilization management processes preferred

Current NY RN license and registration required

CCM preferred

Minimum three to five years nursing experience in long term care, managed care, home care, geriatrics or hospice

Prior experience in an interdisciplinary service delivery environment preferred

Working knowledge of Medicare and Medicaid regulations

Prior experience in an interdisciplinary service delivery environment preferred

Working knowledge of Windows, Word and Excel

Knowledge of current standards of medical practice and healthcare delivery systems

Strong assessment skills

Knowledge of Interqual preferred

Benefits:

We truly value our staff and further acknowledge their contributions by offering:

You’ll find what you’ve been searching for at MJHS.That’s because we’ll appreciate your talent and your dedication to improving the lives of others through top quality patient care. We’ll recognize your contributions, support y...our professional growth, and provide benefits that help you create a well-balanced and rewarding career.You work hard to care for others. And we believe it’s just as important that we care for you in return. You won’t find that everywhere. But you will find it here.We invite you to learn more about the place we call MJHS.